Cardiac Care

About Cardiac Care

Why is this information important?Heart disease is a leading cause of death in Virginia. Some hospitals have lower mortality or readmission rates than others. Use our information to learn more about cardiac care and talk to your doctor.

What information is available? Studies show that experienced hospitals and doctors may have better results in heart care. VHI's report shows how often hospitals provide cardiac care. You will also find how often patients die or must be hospitalized again within 30 days.

Cases Category

(Based on Adjusted Volume)

High

Mid-High

Mid-Low

Low

N/A

Medical

1500+

800-1499

250-799

1-249

0

Invasive

1000+

250-999

100-249

1-99

0

Open Heart

1000+

500-999

100-499

1-99

0

Rating

(More hearts are better)

= Less than expected = As expected = More than expected = Too few to calculate (adjusted volume < 30)

Actual Mortality
The percent of all patients admitted to hospital for a cardiac service line and died during their stay.

Actual Readmission Rate
The percent of all patients admitted to a hospital for a cardiac service line and later readmitted within 30 days to a Virginia hospital for a service related to their prior discharge.

Cardiac Care Service Lines
Patients may have one of many possible conditions and receive different types of diagnostic or surgical procedures. VHI groups these different conditions and treatments into service lines to better compare care provided.

Cardiac Catheterization
or angiogram is a procedure that identifies possible problems with your heart or its arteries. During a cath, a thin plastic tube, called a catheter, is inserted into a blood vessel in your groin or arm. The catheter is guided up toward your heart. A special dye is injected into the catheter so X-rays can show if you have any artery blockage or other heart problems. www.americanheart.org/ presenter.jhtml?identifier=4491

Cardiology - Invasive
Includes patients with medical conditions generally described in the medical cardiology service line that also had surgery. Surgeries include cardiac catheterization, cardiac pacemaker insertion, balloon angioplasty and placement of cardiac stents.

Cardiology - Medical
Includes diagnosing and therapy for heart disease. Angina, congestive heart failure and acute myocardial infarction (AMI) are all examples of heart conditions. When treatment for these conditions does not include surgery, VHI has grouped them into this service line.

Cases Category
The number of adjusted cases (discharges) grouped into four categories for easy comparison.

Congestive Heart Failure (CHF)
or heart failure, is a condition in which the heart can not pump enough blood to the body's other organs.

For more information on signs and symptoms, tests, and treatment, visit: www.americanheart.org/ presenter.jhtml?identifier=4585

Coronary Artery Bypass Graft (CABG)
also called coronary artery bypass surgery, heart bypass or bypass surgery is a surgical procedure performed to relieve angina and reduce the risk of death from coronary artery disease. Arteries and/or veins from elsewhere in the patient's body are grafted from the aorta to the coronary arteries to bypass atherosclerotic narrowings and improve the blood supply to the coronary circulation supplying the myocardium (heart muscle).
More info: http://en.wikipedia.org/wiki/Coronary_artery _bypass_surgery

Expected Mortality
The expected mortality rate is calculated based on the 3M APR-DRG risk of mortality index for patients within a hospital compared to similar patients treated in hospitals across Virginia.

Expected Readmission Rate
The expected readmission rate is calculated based on the 3M APR-DRG and severity index for patients within a hospital compared to similar patients treated in hospitals across Virginia.

Hospice Exclusions
All inpatient hospital discharges that were identified as hospice patients. These patients are identified by one of three methods 1) "v66.7" in the first nine diagnosis codes or those submitted by a facility in the tenth or later diagnosis code or 2) discharge status codes indicating hospice care or 3) revenue codes indicating hospice care.

Mortality Rating
This rating indicates whether the mortality (death) rate is more than expected (), as expected (), or less than expected() at a 95% confidence level. A "Less than expected" () rating is generally best.

Too few to calculate means there were fewer than 30 discharges in the service line and/or subgroup--the threshold VHI set for calculating statistical significance.

Percutaneous Cardiovascular Procedures
These procedures primarily include various types of Coronary Angioplasty. Coronary angioplasty is a medical procedure used to open arteries that have narrowed to the point that they impede blood flow to the heart. This procedure can improve some of the symptoms associated with blocked arteries, such as chest pain and shortness of breath.

Readmission Rating
This rating indicates whether the 30-day related readmission rate is more than expected (), as expected (), or less than expected() at a 95% confidence level. A "Less than expected" () rating is generally best.

Too few to calculate means there were fewer than 30 discharges in the service line and/or subgroup--the threshold VHI set for calculating statistical significance.

Teaching Status
The hospital facility reported membership or accreditation in the Council of Teaching Hospitals and Health Systems (COTH) and/or the Accreditation Council for Graduate Medical Education (ACGME) or they reported no teaching status (NONE.)

Total Cases
All inpatient hospital discharges by cardiac service lines and/or subgroups.

Efficiency Indicators

Composite Score

Scores on individual measures may help with specific aspects of efficiency and productivity, whereas a Composite Score helps with the big picture. Which hospitals are the most efficient?

VHI has a Composite Score for acute care hospitals for the Cost and Productivity/Utilization Indicators (Indicator 3 through 12). This Composite score evaluates the most important aspects of efficiency and productivity and is designed to help employers, large purchasers and providers get an easy-to-grasp idea of a hospital's overall efficiency.

What are Efficiency Indicators?

What Are Efficiency Indicators?
VHI's Efficiency (and Productivity) indicators were designed to help large employers, and purchasers (health insurance companies) to find the most efficient and productive health care providers.

VHI publishes rankings on the Efficiency and Productivity of ambulatory (outpatient) surgical centers, hospitals and nursing facilities each year.

Quartiles.VHI ranks facilities using something called Quartile Rankings. Quartile rankings are a simple way of comparing performance between facilities. To assign quartile rankings all the performance indicators values for a geographic region are sorted from top to bottom. Each facility is assigned a quartile value from 1 to 4.

the first quarter (25%) are assigned a quartile value of 1.

the second quarter (25%) are assigned a quartile value of 2.

the third quarter (25%) are assigned a quartile value of 3

the fourth (25%) are assigned a value of 4

Our web display shows what quartile the facility falls into as well as the actual value for the facility. You can click on any indicator description to get a definition of the indicator and the high and low values for each indicator within each quartile.

Why is this important? Facilities that are efficient may waste less and provide better quality of care by streamlining and reducing unnecessary costs. VHI indicators allow you to see how facilities rank as far as costs and also their profits (operating margins)

Information Sources: Under Virginia law VHI collects audited financial statements and other information from ambulatory surgical centers, hospitals and nursing facilities. VHI reviews and verifies these data and provides these rankings each year based on a facilities fiscal year.

More Information: For more in-depth comparisons VHI has created Excel spreadsheets of the data you see in these web pages. These spreadsheets allow you to compare facility scores side by side. These spreadsheets and more details on the methods VHI uses are part of VHI's Industry Report. For more information click here: Products/industryreport.asp

Charges

Indicator Description

Quartile Rank 1 through 4

Gross revenue per adj. admission ($)

The average full patient charge based on charge schedules per adjusted admission. Admissions are adjusted for case mix and outpatient service revenue. The desired direction is toward a lower value.

Quartile

Min.

Max.

1

18,615.32

25,952.98

2

25,952.98

31,440.80

3

31,440.80

36,341.16

4

36,341.16

96,858.43

(lower is better)

18,615.32

80,414.53

.

4

96,858.43

Net revenue per adj. admission ($)

The average dollar amount expected to be collected per adjusted admission. Admissions are adjusted for case mix and outpatient service revenue. The desired direction is toward a lower value.

Quartile

Min.

Max.

1

5,714.68

7,549.06

2

7,549.06

8,314.01

3

8,314.01

9,465.52

4

9,465.52

16,030.16

(lower is better)

5,714.68

8,894.06

.

3

16,030.16

Costs

Indicator Description

Quartile Rank 1 through 4

Cost per adj. admission ($)

The average total operating costs (adjusted by the wage index) per adjusted admission. Admissions are adjusted for case mix and outpatient service revenue. The desired direction is toward a lower value.

Quartile

Min.

Max.

1

4,780.12

7,284.17

2

7,284.17

8,139.23

3

8,139.23

8,672.56

4

8,672.56

14,928.35

(lower is better)

4,780.12

9,020.00

.

4

14,928.35

Labor cost per adj. admission ($)

The average personnel expenses (adjusted by the wage index) per adjusted admission. Admissions are adjusted for case mix and outpatient service revenue. The desired direction is toward a lower value.

Quartile

Min.

Max.

1

1,663.02

3,289.25

2

3,289.25

3,750.65

3

3,750.65

4,343.09

4

4,343.09

7,641.01

(lower is better)

1,663.02

4,524.19

.

4

7,641.01

Non-labor cost per adj. admission ($)

The average supply, maintenance and non-personnel expenses (adjusted by the wage index) per adjusted admission. Admissions are adjusted for case mix and outpatient service revenue. The desired direction is toward a lower value.

Quartile

Min.

Max.

1

2,139.11

3,216.22

2

3,216.22

3,500.42

3

3,500.42

4,237.38

4

4,237.38

6,891.82

(lower is better)

2,139.11

4,128.95

.

3

6,891.82

Capital cost per adj. admission ($)

The average physical facility costs (e.g., expenses for depreciation, amortization, interest, insurance and taxes as related to the acquisition of permanent assets) per adjusted admission. Admissions are adjusted for case mix and outpatient service revenue. The desired direction is toward a lower value.

Quartile

Min.

Max.

1

-469.05

486.14

2

486.14

603.94

3

603.94

745.94

4

745.94

4,406.74

(lower is better)

-469.05

403.79

.

1

4,406.74

Productivity/Utilization

Indicator Description

Quartile Rank 1 through 4

Full-time equiv. per adj. occupied bed

The number of staff, converted to the average number of employees who work full time, for each occupied bed. The number of occupied beds has been adjusted to account for outpatient service revenue and case mix. The desired direction is toward a lower value.

Quartile

Min.

Max.

1

1.33

3.02

2

3.02

3.34

3

3.34

4.23

4

4.23

6.01

(lower is better)

1.33

3.10

.

2

6.01

Paid hours per adj. admission

The average number of hours the hospital paid to employees or an agency, per adjusted admission. Admissions are adjusted for case mix and outpatient service revenue. The desired direction is toward a lower value.

Quartile

Min.

Max.

1

39.00

73.59

2

73.59

82.22

3

82.22

95.92

4

95.92

178.13

(lower is better)

39.00

95.66

.

3

178.13

Staffed bed occupancy (%)

Expressed as a percentage, the average utilization of the average number of beds, excluding long-term care beds and normal newborn bassinets, that are operational to receive patients during the reporting period. The desired direction is toward a higher value.

Quartile

Max.

Min.

1

114.85

82.09

2

82.09

65.64

3

65.64

52.01

4

52.01

8.27

(higher is better)

114.85

60.17

.

3

8.27

Licensed bed occupancy (%)

Expressed as a percentage, the average utilization of the number of licensed beds reported by the facility, as approved by the Virginia Department of Health. For hospitals, licensed beds exclude normal newborn bassinets, but include neonatal ICU bassinets. The desired direction is toward a higher value.

Quartile

Max.

Min.

1

92.85

67.21

2

67.21

48.42

3

48.42

30.82

4

30.82

8.27

(higher is better)

92.85

45.84

.

3

8.27

Special services utilization (%)

Expressed as a percentage, the average utilization of high capital-cost services that are subject to Certificate of Public Need (COPN) law. Special services include: ICU/CCU, obstetrics, neonatal ICU, MRI, CT, lithotripsy, cardiac catheterization, radiation therapy and cardiac surgery. The desired direction is toward a higher value.

Quartile

Max.

Min.

1

111.53

78.59

2

78.59

61.59

3

61.59

52.27

4

52.27

19.60

(higher is better)

111.53

40.37

.

4

19.60

Case mix adj. avg. length of stay

The average number of days a patient stays in the hospital, adjusted for case mix using the current version of the 3M APR-DRGs. The desired direction is toward a lower value.

Quartile

Min.

Max.

1

2.57

3.23

2

3.23

3.52

3

3.52

3.89

4

3.89

7.85

(lower is better)

2.57

6.05

.

4

7.85

Financial Viability

Indicator Description

Quartile Rank 1 through 4

Cash debt coverage

A measure of the facility's ability to generate cash to cover its long-term debt. The desired direction is toward a higher value.

Quartile

Max.

Min.

1

1,005.84

5.93

2

5.93

1.72

3

1.72

0.00

4

0.00

-11.70

(higher is better)

1,005.84

0.00

.

3

-11.70

Total margin (%)

Total margin expresses the difference between total revenue and cost as a proportion of total revenue. The desired direction is towards a higher value.

Quartile

Max.

Min.

1

41.21

13.05

2

13.05

8.40

3

8.40

0.98

4

0.98

-47.56

(higher is better)

41.21

-0.95

.

4

-47.56

Return on assets (%)

Expressed as a percentage, the facility's ability to generate cash on its financial resources (e.g., investments, receivables, inventory, physical plant, etc.) The desired direction is toward a higher value.

Quartile

Max.

Min.

1

139.73

9.77

2

9.77

6.24

3

6.24

1.60

4

1.60

-79.77

(higher is better)

139.73

28.49

.

1

-79.77

Fixed asset financing ratio

The percentage of asset value financed by long-term debt. The desired direction is toward a lower value.

Quartile

Min.

Max.

1

0.00

0.01

2

0.01

0.04

3

0.04

0.84

4

0.84

14.75

(lower is better)

0.00

0.01

.

1

14.75

Community Support

Indicator Description

Quartile Rank 1 through 4

Charity, bad debt, tax (%)

Expressed as a percentage, the amount of charity care (converted to a cost basis,) bad debt and taxes the facility incurred in relation to its total expenses. The desired direction is toward a higher value.

Quartile

Max.

Min.

1

17.68

10.38

2

10.38

7.68

3

7.68

5.94

4

5.94

-4.55

(higher is better)

17.68

5.16

.

4

-4.55

Medicaid participation (%)

Expressed as a percentage, it is the amount of patient days for patients enrolled in the Medicaid program in relation to total patient days. The number of patient days has been adjusted to account for outpatient service revenue. The desired direction is toward a higher value.

Quartile

Max.

Min.

1

34.06

17.61

2

17.61

13.22

3

13.22

10.15

4

10.15

0.00

(higher is better)

34.06

32.96

.

1

0.00

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Financial Information

Hospital financial information was originally intended to benefit of large employers and purchasers of care.
However, consumers should know that financially healthy hospitals may be better able to provide charity care and invest in infrastructure, and technology. Rankings on financial measures are found within the Efficiency tab.